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Background <p>Bladder pain syndrome/interstitial cystitis (BPS/IC) and vulvodynia frequently co-occur, forming overlapping pelvic pain syndromes that often evade organ-centered management. Shared mechanisms—urothelial/epithelial dysfunction, neuroinflammation, and pelvic floor hypertonicity—support multidisciplinary, mechanism-based care. Because high-quality clinical evidence specifically targeting the BPS/IC + vulvodynia overlap remains limited, this narrative review also evaluates laser-based therapies in clinically adjacent conditions with shared anatomy and pathophysiology (e.g., genitourinary syndrome of menopause and vulvar dermatoses) to contextualize plausibility and inform future study design.</p> Main body <p>Non-ablative erbium-doped yttrium aluminum garnet (Er:YAG) and neodymium-doped yttrium aluminum garnet (Nd:YAG) vaginal/vulvar protocols have shown encouraging improvements in superficial vulvar pain, dyspareunia, sexual function, and—in selecte cohorts—bladder-related symptoms among patients with coexisting BPS/IC and vulvodynia. Transvaginal photobiomodulation (TV-PBM) is emerging as another non-ablative modality with putative mitochondrial, anti-inflammatory, and neuromodulatory effects. Across modalities, histological and imaging reports describe epithelial thickening, glycogen restoration, neovascularization, and collagen remodeling, consistent with tissue repair within the urogynecologic–pelvic floor unit. Proposed mechanisms include sublethal photothermal activation of heat-shock responses, modulation of microvascular tone, and attenuation of inflammatory mediators. Nevertheless, current evidence is dominated by small case series and non-controlled studies with heterogeneous parameters and short follow-up; long-term efficacy, safety, dose, targets, and schedules remain to be standardized. Recent clustering and phenotyping work highlights BPS/IC subtypes—including vulvodynia-predominant groups with distinct psychological and quality-of-life profiles—suggesting that responses to laser modalities are likely phenotype-dependent. In parallel, natural-language analyses reveal “semantic drift” between clinical terms and patients’ everyday symptom language, indicating a role for AI-assisted processing of diaries and free-text to refine phenotyping and endpoint selection.</p> Conclusions <p>Vaginal/vulvar laser therapy and TV-PBM can be positioned as mechanism-specific modules within individualized, multidisciplinary care for BPS/IC and vulvodynia. Priority next steps include adaptive or stratified randomized trials, harmonized energy/targeting protocols, multidimensional patient-reported outcomes, and rational combinations with pelvic floor rehabilitation, hormonal or androgen-sparing approaches, and psychological interventions. Incorporating AI-based profiling and vocabulary mapping into clinical workflows may sharpen subtype recognition and treatment targeting, ultimately improving outcomes for patients with overlapping BPS/IC and vulvodynia.</p>

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Integrating vaginal laser therapy into multidisciplinary management of bladder pain syndrome and vulvodynia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月27日

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  • Nobuo Okui

摘要

Background

Bladder pain syndrome/interstitial cystitis (BPS/IC) and vulvodynia frequently co-occur, forming overlapping pelvic pain syndromes that often evade organ-centered management. Shared mechanisms—urothelial/epithelial dysfunction, neuroinflammation, and pelvic floor hypertonicity—support multidisciplinary, mechanism-based care. Because high-quality clinical evidence specifically targeting the BPS/IC + vulvodynia overlap remains limited, this narrative review also evaluates laser-based therapies in clinically adjacent conditions with shared anatomy and pathophysiology (e.g., genitourinary syndrome of menopause and vulvar dermatoses) to contextualize plausibility and inform future study design.

Main body

Non-ablative erbium-doped yttrium aluminum garnet (Er:YAG) and neodymium-doped yttrium aluminum garnet (Nd:YAG) vaginal/vulvar protocols have shown encouraging improvements in superficial vulvar pain, dyspareunia, sexual function, and—in selecte cohorts—bladder-related symptoms among patients with coexisting BPS/IC and vulvodynia. Transvaginal photobiomodulation (TV-PBM) is emerging as another non-ablative modality with putative mitochondrial, anti-inflammatory, and neuromodulatory effects. Across modalities, histological and imaging reports describe epithelial thickening, glycogen restoration, neovascularization, and collagen remodeling, consistent with tissue repair within the urogynecologic–pelvic floor unit. Proposed mechanisms include sublethal photothermal activation of heat-shock responses, modulation of microvascular tone, and attenuation of inflammatory mediators. Nevertheless, current evidence is dominated by small case series and non-controlled studies with heterogeneous parameters and short follow-up; long-term efficacy, safety, dose, targets, and schedules remain to be standardized. Recent clustering and phenotyping work highlights BPS/IC subtypes—including vulvodynia-predominant groups with distinct psychological and quality-of-life profiles—suggesting that responses to laser modalities are likely phenotype-dependent. In parallel, natural-language analyses reveal “semantic drift” between clinical terms and patients’ everyday symptom language, indicating a role for AI-assisted processing of diaries and free-text to refine phenotyping and endpoint selection.

Conclusions

Vaginal/vulvar laser therapy and TV-PBM can be positioned as mechanism-specific modules within individualized, multidisciplinary care for BPS/IC and vulvodynia. Priority next steps include adaptive or stratified randomized trials, harmonized energy/targeting protocols, multidimensional patient-reported outcomes, and rational combinations with pelvic floor rehabilitation, hormonal or androgen-sparing approaches, and psychological interventions. Incorporating AI-based profiling and vocabulary mapping into clinical workflows may sharpen subtype recognition and treatment targeting, ultimately improving outcomes for patients with overlapping BPS/IC and vulvodynia.